Provider Demographics
NPI:1366836181
Name:HARGETT, VANESSA LYNNE (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:LYNNE
Last Name:HARGETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:LYNNE
Other - Last Name:CALLAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17350 ST LUKES WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4103
Mailing Address - Country:US
Mailing Address - Phone:936-266-5054
Mailing Address - Fax:
Practice Address - Street 1:17350 ST LUKES WAY STE 200
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-266-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP127405OtherAPRN LICENSE #
TX1366836181OtherNPI